Ketamine Infusion for Postoperative Pain Management in Patients Undergoing Knee Arthroplasty: A Prospective Randomized Single-Center Study



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Abstract

BACKGROUND: Ketamine is an NMDA receptor antagonist with potent analgesic properties and is widely used as part of multimodal postoperative analgesia. This study aims to evaluate its efficacy and safety for pain management following total knee arthroplasty, with particular attention to the risk of neuropsychiatric side effects.

AIM: To assess the efficacy and safety of ketamine infusion for postoperative analgesia in patients undergoing knee arthroplasty.

METHODS: A prospective, randomized, controlled trial was conducted involving 68 patients undergoing knee arthroplasty. Patients were randomly assigned to two groups: Ketamine group: Received postoperative ketamine infusion. Control group: Received standard postoperative analgesia. Primary endpoints included pain intensity (Numerical Rating Scale, NRS), opioid consumption, and incidence of adverse effects (nausea, vomiting, neuropsychiatric side effects).

RESULTS: Ketamine administration resulted in significant pain reduction within the first 10 hours postoperatively (p=0.03) and a decrease in morphine consumption (p=0.0002) compared to the control group. However, the incidence of mild to moderate neuropsychiatric adverse effects was higher in the ketamine group (32.35% vs. 0%, p=0.0001, Fisher’s exact test). The incidence of severe neuropsychiatric adverse effects was comparable between groups (2.94% in both). The percentage of patients with insufficient analgesia was identical in both groups (5.9%).

CONCLUSION: Ketamine infusion is an effective postoperative analgesic strategy, significantly reducing opioid consumption. However, it is associated with a higher incidence of neuropsychiatric side effects (hallucinations, anxiety, disorientation). Optimizing dosing regimens may mitigate these adverse effects, reinforcing ketamine as a valuable component of multimodal analgesia.

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About the authors

Ivan S. Shcheparev

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Email: is22@list.ru
ORCID iD: 0000-0002-0432-135X

anesthesiologist-resuscitation

Russian Federation, Moscow, Russia

Boris A. Teplykh

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Email: batru@mail.ru
ORCID iD: 0000-0002-1784-9540

anesthesiologist-resuscitation

Russian Federation, Moscow, Russia

Zhanna N. Fedotova

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Author for correspondence.
Email: Breyn3012@yandex.ru
ORCID iD: 0009-0008-3253-7351

anesthesiologist-resuscitation

Russian Federation, Moscow, Russia

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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